Curative effect analysis of laparoscopic conservative surgery combined with drug in treatment of moderate/severe endometriosis and the therapeutic evaluation of dienoges for recurrent endometriosis-associated pelvic pain

Abstract

Objective To investigate the curative effect of laparoscopic conservative surgery combined with commonly used drugs in treatment of moderate and severe endometriosis (EMS), and the curative effect and security of dienogest in the treatment of recurrent endometriosis-associated pelvic pain (EAPP). Methods Totally 432 patients who had a laparoscopic conservative surgery in the treatment of EMS from January 2007 to January 2014 were analyzed retrospectively and follow-up visited. These patients were divided into 4 groups by different postoperative drugs: group A (laparoscopic conservative surgery alone), group B [laparoscopic conservative surgery combined with gonadotropin releasing hormone agonist (GnRH-a)], group C [laparoscopic conservative surgery combined with levonorgestrel releasing intrauterine system (IUS-LNG)] and group D (laparoscopic conservative surgery combined with gestrinone). Fifteen patients with recurrent EAPP used dienogest 2 mg daily for 6-13 cycles. The remission of EAPP in each group, the postoperative pregnancy rate/time of infertile EMS patients, and the recurrence rate/time of EMS were analyzed. The curative effect and security of dienogest in the treatment of EAPP was assessed. Results 1) The visual analogue score (VAS) of EAPP patients were improved significantly after treatment in each group, patients in group B and group C improved more. 2) The recurrence rate and recurrence time of EMS showed no statistical difference among four groups. 3) The pregnancy rate of infertile patients was 40.0% in group A, 65.21% in group B and 50.0% in group D; group B improved more. 4) The VAS scores of EAPP recurrence patients after treatment with dienogest showed statistical difference with before. Conclusions 1) Laparoscopic conservative surgery alone or laparoscopic conservative surgery combined with drug both could relieve EAPP and improve pregnancy rate. 2) Laparoscopic conservative surgery combined with GnRH-a or IUS-LNG could relieve EAPP more significantly. Laparoscopic conservative surgery combined with GnRH-a could improve the pregnancy rate, and do not prolong postoperative pregnancy time. 3) There were no statistical differences of the recurrence rate and postoperative recurrence time of EMS between laparoscopic conservative surgery alone and laparoscopic conservative surgery combined with drug. 4) Dienogest was expected to be an ideal drug in treatment of EAPP recurrence. Key words: Endometriosis (EMS); Endometriosis-associated pelvic pain (EAPP); Treatment; Dienogest